Provider Demographics
NPI:1295749893
Name:PARKER, MARY (PHD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:LLEWELLYN
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:3223 E 31ST ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-2444
Mailing Address - Country:US
Mailing Address - Phone:918-749-6935
Mailing Address - Fax:
Practice Address - Street 1:3223 E 31ST ST
Practice Address - Street 2:SUITE 201
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-2444
Practice Address - Country:US
Practice Address - Phone:918-749-6935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK625103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK232800301Medicare PIN